FLUIDS AND ELECTROLYES IMBALANCES Flashcards
❖ Loss of body fluid causing a decrease in blood volume.
(Fluid Volume Deficit)
HYPOVOLEMIA
Fluid losses such as those resulting from:
→ Once FVD develops, kidneys attempt to conserve body fluids resulting:
vomiting, diarrhea, GI suctioning, and sweating; decreased intake, as in nausea or lack of access to fluids; and third-space fluid shifts.
UO of less than 1mL/h
is a condition that causes excessive urination, and this is due to the inability of the kidneys to respond to ADH which can increase urine formation causing polyuria.
Diabetes Insipidus
❖ DIAGNOSTIC FINDINGS OF HYPOVOLEMIA
→ can occur with GI & renal losses as these organs are major regulators of potassium.
Hypokalemia
❖ DIAGNOSTIC FINDINGS OF HYPOVOLEMIA
→ can occur with adrenal insufficiency due to aldosterone deficiency which causes lack of potassium excretion.
▪ Aldosterone deficiency decreases Na reabsorption, leading to increased Na excretion. The relationship between Na and K = when Na is reabsorbed, K is excreted to maintain electrolyte balance. However, due to aldosterone deficiency, both Na excretion and K retention can occur causing hyperkalemia.
Hyperkalemia
❖ DIAGNOSTIC FINDINGS OF HYPOVOLEMIA
→ occurs with increased thirst and ADH release, which increases water content of the bloodstream.
▪ Excessive water in the body dilutes the fluids
Hyponatremia
ASSESSMENT
S/Sx
Decreased Urine Output (EXPLAIN)
➢ dehydration > hypothalamus will sense it > stimulate PPG to release ADH > ADH prevents kidney from releasing urine by stimulating renal tubules to reabsorb water
❖ DIAGNOSTIC FINDINGS OF HYPOVOLEMIA
→ can result from increased insensible water losses and diabetes insipidus,
Hypomagnesemia
❖ DIAGNOSTIC FINDINGS OF HYPOVOLEMIA
→ may or may not be present.
▪ NORMAL UO: 1L per day
▪ POLYURIA: increased urination (DM and DI)
▪ OLIGURIA: decreased urination 400–600 mL
▪ ANURIA: only excreting 50mL in 24 hours
Oliguria
❖ MEDICAL MANAGEMENT
→ Antidiarrheal
→ Isotonic Electrolyte Crystalloid Solutions
→ Hypotonic Electrolyte Solution
→ Antidiarrheal such as loperamide and bismuth subsalicylate.
→ If not severe, oral route is preferred. If acute or severe, IV route is required.
→ Isotonic Electrolyte Crystalloid Solutions
▪ These are frequently the first-line choice to treat the hypotensive patient with FVD because they expand plasma volume.
▪ e.g., lactated Ringer’s solution or 0.9% sodium chloride
→ Hypotonic Electrolyte Solution
▪ If patient becomes normotensive, this is often used to provide both electrolytes and water for renal excretion of metabolic wastes.
▪ (e.g., 0.45% sodium chloride)
HYPERVOLEMIA (Fluid Volume Excess)
❖ Excessive retention of fluid in the body that can increase blood volume.
→ FVE may be related to simple fluid overload or diminished function of the homeostatic mechanisms responsible for regulating fluid balance.
HYPERVOLEMIA
❖ NURSING INTERVENTIONS HYPOVOLEMIA
→ Monitor VS every 4 hours. (↓ BP & ↑PR)
→ Promote adequate fluid replacement.
▪ IV fluids
▪ Oral Rehydration Solutions
➢ These provide fluids, glucose, and electrolytes – easily absorbed.
➢ e.g., rehydralyte, elete, and cytomax
→ Monitor and measure I&O to determine when therapy should be slowed to avoid volume overload.
▪ Report if urine output is below 250cc/8hrs.
▪ Normal: 240 to 250 cc per 8 hours
→ Provide oral hygiene several times per day.
▪ Dry mouth causes bad breath (halitosis)
▪ Oral hygiene ᛏ amount of saliva (saliva has plenty of lysosomes which can kill bacteria in the mouth).
→ Routinely check body weight.
▪ Loss of 0.5kg (1.1lb) = 500mL fluid loss
▪ 1L of fluid = 1kg or 2.2lb
→ Monitor lab results such as:
▪ ↑ Blood Urea Nitrogen, creatinine, Hematocrit Blood Test, serum and urine osmolality, and specific gravity; ↓urine
sodium
→ This can occur due to increased capillary fluid pressure, decreased capillary oncotic pressure, or increased interstitial oncotic pressure.
▪ Hypervolemia can cause edema due to liver, heart, and lung failure resulting to excess fluids in the body; These fluids will go to the third spaces in the body causing edema
EDEMA
❖ NURSING INTERVENTIONS
→ Monitor and measure I&O and daily weight.
→ Assess breath sounds at regular intervals.
▪ Abnormal breath sounds heard in patients with FVE are crackles, wheezing, rhonchi.
→ Monitor the degree of edema (press using thumb); on a scale of 1+ (minimal) to 4+ (severe).
→ Regular rest periods may be beneficial because it supports the body’s diuresis process, helping to reduce the excess fluid load.
▪ In a supine position, the blood in the lower extremity travels more in the abdomen area and more blood will go to the kidneys which increase urine formation = excretion.
→ Advise the patient to avoid foods high in sodium such as sausage, bacons, seafood, fish or poultry, canned goods, pizza, processed cheese, pickles,tomato sauce, breads, and soy sauce.
→ Advise the patient to eat seasoning substitutes such as onion, garlic, and lemon juice to decrease sodium intake.
→ Advise malnourished patients to increase protein intake such as egg, chicken breast, salmon, tuna, beef, cottage cheese, and almonds to increase capillary oncotic pressure; Increased COP will pull fluid out of the tissues into vessels for excretion by
the kidneys.
→ If dyspnea or orthopnea is present, place the patient in a semi-Fowler position to promote lungexpansion.
▪ Orthopnea occurs when patient is having difficulties in breathing while lying and it is relieved by sitting.
→ Reposition the patient at regular intervals because edematous tissue is more prone to skin breakdown than normal tissue.
▪ Epidermis has no vessels while dermis has, epidermis gets nutrients at the dermis. The water will go to the space between the dermis and vessels, causing the epidermis to detach from the dermis or be destroyed resulting to bedsores.
→ Instruct patient to use anti-embolic stockings because this helps improve blood circulation, which can prevent fluid from pooling in the legs and reduce edema.
→ Monitor lab results:
▪ Labs indicate: ↓ BUN, hemoglobin &hematocrit, serum and urine osmolality; and ↑urine sodium and specific gravity
Types of Edema
▪ It can be localized (e.g., ankle, rheumatoid arthritis).
▪ It can be generalized (e.g., cardiac failure and kidney injury).
▪ ____ – severe generalized edema
Anasarca
→ Functions: (Nervous System)
▪ transmission and conduction of the nerve impulse; contractility of the muscles
▪ attracts fluid and helps preserve the ECF and fluid volume distribution on the body
▪ combines w/ chloride and bicarbonate to regulate acid-base balance
(most abundant in ECF)
❖ SODIUM Na+
Foods high in sodium:
▪ Sausage, bacons, seafood, fish or poultry, canned goods, pizza, processed cheese, pickles, tomato sauce, breads, and soy sauce.
SODIUM → Normal Value:
▪ ECF: mEq/L
▪ ICF: mEq/L
135-145
10-14
→ Sodium level is less than 135 mEq/L.
▪ Plenty of Na is inside the cells and this attracts the water at the ECF to also go inside the cells which causes swelling = rupture; and this can lead to seizures.
▪ This is due to excessive intake of fluids making the sodium diluted
HYPONATREMIA
→ Nursing Management: HYPONATREMIA
▪ Monitor vital sings at regular intervals. This condition causes ↑PR and ↓ BP.
▪ Monitor I&O and body weight at regular intervals.
▪ Advice patient to restrict fluid intake and eat sodium rich foods.
▪ If seizures occur:
➢ Immediately protect the head, put a pillow or anything soft.
➢ Side rails up and put pillows at the side of the patients to prevent fall.
➢ Place patient on a side-lying position and turn the head on one side to prevent aspiration.
➢ Don’t put anything in the mouth, because it can push the tongue at the back which can block the airway; it can break the teeth.
➢ Don’t hold the extremities because it can cause fracture or any injury
▪ If patient can’t consume sodium orally, lactated Ringer’s solution or isotonic saline (0.9% sodium chloride) solution may be prescribed.
→ Sodium level is greater than 145 mEq/L.
▪ There is high Na level outside the cells which pulls water out of cells causing cell shrinkage (dies). When brain cells lose too much water, they shrink and this can trigger abnormal electrical activity = seizure.
▪ Thirst (mechanism) is the body’s main defense against hyp_rnatremia
▪ Fluid deprivation in patients that can’t drink voluntarily: infants, confused elderly people, and unconscious or cognitive impaired px.
▪ Increased intake of sodium (Oral / IV)
HYPERNATREMIA
OTHER REMINDERS FOR HYPERNATREMIA
▪ Enteral feeding without adequate water supplement.
➢ Hypertonic Solution: particles is higher than water
✓ example: osteorized feeding (TPN) – plenty of salt will attract
water
➢ Osteorized Feeding for patients who can’t eat.
Place patient in a sitting position. The doctor will insert a nasogastric tube, instruct patient to do swallowing reflexes while tube is being inserted.
✓ Length of tube: earlobes to the tip of the nose then tip of nose to the xiphoid process.
✓ Dietician makes the osteorized content.
✓ Osteorized can block the tube so flush it with 50cc of water.
➢ Hypernatremia can result from Diabetes Insipidus, where the kidneys fail to respond to ADH. This causes increased water excretion, leading to excessive urination and loss of water from the body.
.
→ Nursing Management: HYPERNATREMIA
▪ Monitor vital signs at regular intervals. This condition causes ↑PR, BP, and Temperature.
▪ Advice the patient to increase fluid intakeand avoid foods rich in sodium.
▪ Observe for changes in neurologic status, such as confusion, disorientation, and possible decreased level of consciousness.
→ Correcting hypernatremia too quickly could cause water to shift rapidly into the cells and may cause the brain cells to swell.
cerebral edema
Functions: (CVS System)
▪ Promotes transmission and conduction of nerve impulses and the contraction of skeletal, cardiac, and smooth muscles.
▪ Assists in the regulation of intracellular osmolality.
▪ Assists in the maintenance of acid-base balance.
➢ K in acid-base balance allows the acid (hydrogen ions) to enter the cells.
❖ POTASSIUM K+
Foods rich in potassium:
▪ Banana, cantaloupe, honeydew, orange juice, potato, dried fruits, raisin, milk, citrus, whole grain, avocado, beans, fish, spinach, and peaches
Normal Value of Potassium:
▪ ECF: ____ mEq/L
▪ ICF: ____ mEq/L
3.5-5
140-150
A serum K level less than 2.5 mEq/L or greater than 7.0 mEq/L may result in _____
cardiac arrest
ECG:
Atrial Depolarization (contraction)
➢ Atrium Contraction; AV Valves are open; SV are close; giving blood to the ventricles.
P
ECG:
The stimulus travels from SA Node to AV Node; Holds the AV Node to open allowing the blood to be filled in the ventricles.
▪ PR INTERVAL
ECG:
Ventricular Depolarization
➢ dapat maliit lang yung Q
➢ Ventricular Contraction; AV Valves close; SV are open
QRS
ECG:
Early Ventricular Repolarization
➢ Ventricles are starting to rest
ST
ECG:
Ventricular Repolarization (relaxation)
➢ Complete relaxation of ventricles.
➢ Atrium starts contracting again.
T
Potassium level is less than 3.5 mEq/L.
▪ Severe Hypokalemia – cardiac arrest or respiratory arrest = death
HYPOKALEMIA